CXR Flashcards
What’s the first thing you do when interpreting a CXR?
Confirm the patient’s details:
- name, DOB, hosp no.
- date and time of film
- previous imaging
What’s the next step after confirming patient’s details?
Assess the quality of the image (RIPE)
What does RIPE stand for?
Rotation
Inspiration
Projection
Exposure
What do you check for in ‘rotation’?
Clavicles should be equidistant to spinous processes
What do you check for in ‘inspiration’?
5-6 anterior ribs OR
10-11 posterior ribs should be visible
How do you know which ones the anterior ribs are?
The anterior ribs are the ones that curve downwards
What do you check for in ‘projection’?
PA or AP
Differentiate between AP and PA
PA = scapula more lateral AP = scapula more medial
What do you check for in ‘exposure’?
Vertebrae should be visible behind the heart
What is one key thing you should always remember about the AP?
Heart size cannot be assessed accurately on an AP as it is imaged from the front!! Therefore beware of it seeming like cardiomegaly when it’s actually normal!
What does the ABCDE stand for?
Airway Breathing Cardiac Diaphragm Everything else
What do you look for when assessing the airway?
Trachea - is it deviated or central?
Carina and bronchi - association with NG tube
Hilar structures - are they symmetrical bilaterally or unilaterally?
What could bilateral hilar enlargement suggest?
Sarcoidosis/TB
What do you when assessing breathing?
Lung fields - look by thirds
Pleura - normally shouldn’t be visible
What might a thickened pleura suggest?
Mesothelioma due to asbestos
What might pleura that doesn’t extend to the edge suggest?
Pneumothorax
What might opacification in the lower lobes suggest?
Pneumonia
What do you assess when looking at the cardiac side of things?
Heart size (PA) Heart borders
When would it be classified as cardiomegaly?
When heart size >50% thoracic width
What would reduced definition of the right heart border suggest?
Right middle lobe consolidation
What would reduced definition of the left heart border suggest?
Reduced definition of left heart border = lingula consolidation
Which diaphragm is normally higher?
right one
left is lower
What else do you look for when assessing diaphragm?
Costophrenic angles
-fluid
-consolidation
lung hyperinflation
What do you call it when there is air under the diaphragm?
Pneumoperitoneum
What counts as ‘everything else’?
Aortic knuckle Mediastinal width Bones Soft tissues Tubes, valves, pacemakers
Finally, what areas must you review?
HARP
Hilar regions
Apices
Retrocardiac regions
Peripheries
What do you call metastatic lung cancer that presents as multiple fluffy spots in the lungs?
Cannonball metastases
As part of management, what do you need to say?
Investigations as well as next steps
What would be part of investigations? Bloods? Imaging? Other?
Bloods:
- ABGs/VBGs
- FBC
- U&Es
- D-dimer
- Troponin
- BNPs
Imaging
-echocardiogram
Check for ankle swelling
Management might include
Sitting them up, 45 degrees Oxygen Loop diuretics (if pul oedema, pleural effusion) Nitrate CPAP
Antibiotics
What can venous blood gas tell you that ABGs won’t tell you?
lactic acid
When should you not give nitrates?
Aortic stenosis
Low BP
What differentiates an AP xray?
Scapula shadow
If you see a patient with consolidation that suggests pneumonia, what would you need to do?
If pneumonia, do CURB65 FBC U and E CRP/ESR Blood culture Arterial blood gas
Check whether the patient has had any previous hospitalisation due to similar chest infection
What imaging test would you need to do if the pneumonia doesn’t improve?
CT after 3 weeks
